Provider Demographics
NPI:1245617240
Name:BURNS, JULIE (MS, RD, CCN)
Entity Type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:MS, RD, CCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 GILBERT AVE
Mailing Address - Street 2:SUITE 218
Mailing Address - City:WESTERN SPRINGS
Mailing Address - State:IL
Mailing Address - Zip Code:60558-1753
Mailing Address - Country:US
Mailing Address - Phone:708-792-3587
Mailing Address - Fax:708-246-9784
Practice Address - Street 1:4911 LAWN AVE
Practice Address - Street 2:
Practice Address - City:WESTERN SPRINGS
Practice Address - State:IL
Practice Address - Zip Code:60558-1732
Practice Address - Country:US
Practice Address - Phone:708-792-3587
Practice Address - Fax:708-246-8797
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164.001960133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered